NEW YORK
state department of
Nirav R. Shah, M.D., M.P.H.
Commissioner
HEALTH
Sue Kelly
Executive Deputy Commissioner
September 30, 2013
Mr. Michael Melendez
Associate Regional Administrator
Department of Health & Human Services
Centers for Medicare & Medicaid Services
New York Regional Office
Division of Medicaid and Children's Health Operations
26 Federal Plaza - Room 37-100 North
New York, New York 10278
RE: SPA #13-23
Non-Institutional Services
Dear Mr. Melendez:
The State requests approval of the enclosed amendment #13-23 to the Title XIX (Medicaid) State
Plan for non-institutional services to be effective July 1, 2013 (Appendix I). This amendment is being
submitted based on existing legislation. A summary of the amendment is provided in Appendix II.
The State of New York reimburses these services through the use of rates that are consistent with
and promote efficiency, economy, and quality of care and are sufficient to enlist enough providers so that
care and services are available under the State Plan at least to the extent that such care and services are
available to the general population in the geographic area as required by § 1902(a)(30) of the Social
Security Act and 42 CFR §447.204.
Copies of pertinent sections of existing State statute are enclosed for your information (Appendix
III). A copy of the public notice of this plan amendment, which was given in the New York State
Register on September 26, 2012, is also enclosed for your information (Appendix IV). In addition,
responses to the standard access questions, which include Affordable Care Act (ACA) and tribal
assurances, are also enclosed (Appendix V).
If you have any questions regarding this State Plan submission, please do not hesitate to contact
John E. Ulberg, Jr., Medicaid Chief Financial Officer, Division of Finance and Rate Setting at
(518) 474-6350.
Sincerely,
erson
aid Di lctor
Office\pf Heath Insurance Programs
Enclosures
­
­
DEPARTMENT OF HEALTH AND HUMAN SERVICES
HEALTH CARE FINANCING ADMINISTRATION
FORM APPROVED
OMB NO. 0938-019
TRANSMITTAL AND NOTICE OF APPROVAL OF
STATE PLAN MATERIAL
1. TRANSMITTAL NUMBER:
13-23
2. STATE
New York
FOR: HEALTH CARE FINANCING ADMINISTRATION
3. PROGRAM IDENTIFICATION:­ TITLE XIX OF THE
SOCIAL SECURITY ACT (MEDICAID)
TO: REGIONAL ADMINISTRATOR
HEALTH CARE FINANCING ADMINISTRATION
DEPARTMENT OF HEALTH AND HUMAN SERVICES
5. TYPE OF PLAN MATERIAL (Check One):
4. PROPOSED EFFECTIVE DATE
July 1, 2013
q NEW STATE PLAN
q AMENDMENT TO BE CONSIDERED AS NEW PLAN
AMENDMENT
COMPLETE BLOCKS 6 THRU 10 IF THIS IS AN AMENDMENT (Separate Transmittal or each amendment)
6. FEDERAL STATUTE/REGULATION CITATION:
7. FEDERAL BUDGET IMPACT:
1902(a) of the Social Security Act
a. FFY 07/01/13-09/30/13 $ 195,182
b. FFY 10/01/13-09/30/14 $ (1,647,221)
8. PAGE NUMBER OF THE PLAN SECTION OR ATTACHMENT:
9. PAGE NUMBER OF THE SUPERSEDED PLAN
SECTION OR ATTACHMENT (If Applicable):
Attachment 3.1-D: Pages 2, 3, 4
Attachment 3.1-D: Pages 2, 3
10. SUBJECT OF AMENDMENT:
Medicaid Transportation Management
(FMAP = 50%)
11. GOVERNOR'S REVIEW (Check One):
® GOVERNOR'S OFFICE REPORTED NO COMMENT
q COMMENTS OF GOVERNOR'S OFFICE ENCLOSED
q NO REPLY RECEIVED WITHIN 45 DAYS OF SUBMITTAL
12. SAT
OF STATE AGENCY OFFICIAL:
13. TYPE­ N ME:
16. RETURN TO:
New York State Department of Health
Bureau of Federal Relations & Provider Assessments
99 Washington Ave - One Commerce Plaza
Suite 1430
Albany, NY 12210
son A. Helgerson
a icaid Director
Department of Health
15. DATE SUBMITTED:
September 30,
14. TITLE:­
17. DATE RECEIVED:­
q OTHER, AS SPECIFIED:
2013
FOR REGIONAL OFFICE USE ONLY
18. DATE APPROVED:
PLAN APPROVED - ONE COPY ATTACHED
19. EFFECTIVE DATE OF APPROVED MATERIAL:
20. SIGNATURE OF REGIONAL OFFICIAL:
21. TYPED NAME:
23. REMARKS:
FORM HCFA-179 (07-92)
22. TITLE:
Appendix I
2013 Title XIX State Plan
Third Quarter Amendment
Non-Institutional Services
Amended SPA Pages
Attachment 3.1-D
New York
Page 2
d. the geographic locations of the MA recipient and the provider of medical care and services;
e. the medical care and services available within the common medical marketing area of the MA
recipient's community;
f.
the need to continue a regimen of medical care or service with a specific provider; and,
g. any other circumstances which are unique to a particular MA recipient and which the prior
authorization official determines have an effect on the need for payment of transportation
services.
The decision to require the MA recipient to travel using a personal vehicle, public transit, or taxi is made by the
prior authorization official based upon the prior authorization official's knowledge of personal vehicle
ownership and the local public transit routes. When a more specialized mode of transportation is required,
such as wheelchair or stretcher van, or ambulance, the prior authorization official will make a decision on the
proper mode of transport after consideration of information obtained from a medical practitioner, supervisors,
the Department, program guidance materials, and any other source available, that will help the official to
make a reasoned decision.
B.
Payment
1. Criteria to be used when establishing payment for medical assistance transportation:
a. Social services districts, except those where the Commissioner of Health has assumed the
management of transportation [management] services, have the authority to establish
payment rates with vendors of transportation services which will ensure the efficient
provision of appropriate transportation for MA recipients in order for the recipients to obtain
necessary medical care or services. Social services districts may establish such rates in a
number of ways, which may include negotiation with the vendors. However, no established
rate will be reimbursed unless that rate has been approved by the Department as the
Department established rate.
i. The State defines "department established rate" as the rate for any given mode of
transportation which the department has determined will ensure the efficient
provision of appropriate transportation to MA recipients in order for the recipients to
obtain necessary medical care and services.
ii. The department may either establish rate schedules at which transportation services
can be assured or delegate such authority to the social services districts. Delegation
of authority exists only in episodic circumstances in which immediate transportation
is needed at a cost not considered in the established fee schedule. In order to
ensure access to needed medical care and service, the social services districts will
approve a rate to satisfy the immediate need.
iii. Plans, rate schedules or amendments may not be implemented without
departmental approval.
iv. Social services districts have no authority to establish a fee schedule without the
Department's involvement; there is no incongruity between the Department's and
social services district's fee schedules.
TN#:
13- 23
Supersedes TN#:
Approval Date:
12-33
Effective Date:
Attachment 3.1-D
New York
3
v. Payment for reimbursement of the MA recipient's use of a personal vehicle will be made at
the Internal Revenue Service's established rate for Medical Mileage. Payment of
reimbursement for use of a personal vehicle of a volunteer driver or family mem[e]ber of a
MA recipient will be made at the Internal Revenue Service's established rate for Standard
Mileage.
b. Payment for transportation is only available for transportation to and from providers of
necessary medical care and services which can be paid for under the MA program.
MA
payment for transportation will not be made if the care or services are not covered under the
MA program.
c. MA payment to vendors of transportation services is limited to situations where an MA recipient
is actually being transported in the vehicle.
d. MA payment will not generally be made for transportation which is ordinarily made available to
other persons in the community without charge. If federal financial participation is available for
the costs of such transportation, the MA program is permitted to pay for the transportation.
e. Vendors of transportation services must provide pertinent cost data to a social services district
upon request or risk termination from participation in the MA program.
Finally, the provisions require social services districts, except those where the Commissioner of Health
assumed management of transportation services, to notify applicants for and recipients of MA of the
procedures for obtaining prior authorization of transportation services.
C. Transportation Management
The following table depicts, for each county, whether the county department of social services or State
manages the transportation Droaram.
Managed b Local Department of Social Services Managed by De partment of Health Under Contract
Allegany
Monroe
Albany
Queens
Cattaraugus
Chautauqua
Chenango
Clinton
Cortland
Nassau
Niagara
Ontario
Orleans
Oswego
Otsego
Bronx
Broome
Cayuga
Columbia
Delaware
Dutchess
Rensselaer
Richmond
Rockland
Saratoga
Schenectady
Schoharie
Erie
Schuyler
Essex
Sullivan
Franklin
Genesee
Seneca
St. Lawrence
Fulton
Greene
Ulster
Warren
Hamilton
Steuben
Kings
Washington
Herkimer
Jefferson
Lewis
Livingston
Madison
Suffolk
Suffolk
Tioga
Tompkins
Wayne
Wyoming
Yates
Montgomery
New York
Oneida
Onondaga
Orange
Putnam
Westchester
Chemung
TN#:
13- 23
Supersedes TN#:
#12- 33
Approval Date:
Effective Date:
Attachment 3.1-D
New York
4
Managed by Local
Department of
Managed by Department of Health Under Contract
Social Service ;':,
Alle an
Albany
Kings
Cattarau us
Chautauqua
Erie
Genesee
Nassau
Niagara
Suffolk
Wyoming
TN#:
Bronx
Broome
Cayuga
Chemun
Chenan o
Clinton
Columbia
Cortland
Delaware
Dutchess
Essex
Franklin
Fulton
Greene
Hamilton
Herkimer
Jefferson
13- 23
Supersedes TN#:
NEW
Lewis
Livingston
Madison
Monroe
Mont ome
New York
Oneida
Onondaga
Ontario
Oran e
Orleans
Oswego
Otsego
Putnam
Queens
Rensselaer
Richmond
Approval Date:
Effective Date:
Rockland
Sarato a
Schenectad
Schoharie
Schuyler
Seneca
Steuben
St. Lawrence
Sullivan
Tio a
Tom kips
Ulster
Warren
Wain to^n
Wayne
Westchester
Yates
Appendix II
2013 Title XIX State Plan
Third Quarter Amendment
Non-Institutional Services
Summary
SUMMARY
SPA #13-23
This State Plan Amendment proposes to move twenty-four counties under
Department of Social Services control to State control for Medicaid Transportation
Management.
Appendix III
2013 Title XIX State Plan
Third Quarter Amendment
Non-Institutional Services
Authorizing Provisions
­
SPA 13-23
CHAPTER 109 OF THE LAWS OF 2010 - S.8090 /A.11372
§ 20. Section 365-h of the social services law, as added by chapter 81
of the laws of 1995 and subdivision 3 as amended by section 26 of part B
of chapter 1 of the laws of 2002, is amended to read as follows:
§
365-h.
Provision and reimbursement of transportation costs. 1. The
local social services official and, subject to the provisions of subdi­
vision four of this section, the commissioner of health shall have
responsibility for prior authorizing transportation of eligible persons
and for limiting the provision of such transportation to those recipi­
ents and circumstances where such transportation is essential, medically
necessary and appropriate to obtain medical care, services or supplies
otherwise available under this title.
2.
In exercising this responsibility, the local social services offi­
cial and, as appropriate, the commissioner of health shall:
(a) make appropriate and economical use of transportation resources
available
in the district in meeting the anticipated demand for trans­
portation within the district, including, but not limited to: transpor­
tation generally available free-of-charge to the general public or
specific
segments
of the general public,
public transportation,
promotion of group rides, county vehicles, coordinated transportation,
and direct purchase of services; and
(b) maintain quality assurance mechanisms in order to ensure that (i)
only such transportation as is essential, medically necessary and appro­
priate to obtain medical care, services or supplies otherwise available
under this title is provided [ate]; (ii) no expenditures for taxi or
livery transportation are made when public transportation or lower cost
transportation is reasonably available to eligible persons; and (iii)
transportation services are p rovided in a safe, timely,
and reliable
manner by providers that comply with state and local regulatory require­
ments and meet consumer satisfaction criteria approved by the commis­
sioner of health.
3. In the event that coordination or other such cost savings measures
are implemented, the commissioner shall assure compliance with applica­
ble standards governing the safety and quality of transportation of the
population served.
4.
The commissioner of health is authorized to assume responsibility
from a local social services official for the provision
and reimburse­
ment of transportation costs under this section. If the commissioner
elects to assume such responsibility, the commissioner shall notify the
local
social
services official in writing as to the election, the date
upon which the election shall be effective and such information as to
transition of responsibilities
as the commissioner deems prudent. The
commissioner is authorized to contract with a transportation manager or
managers
to manage transportation services in any local social services
district. Any transportation manager or managers selected by the commis­
sioner to manage transportation services shall have p roven experience in
coordinating transportation services in a geographic and demographic
area similar
to the area in New York state within which the contractor
would manage the provision of services under this
section.
Such
a
contract
or contracts may include responsibility for: review, approval
and processing of transportation orders; management of the ap ropriate
level of transportation based on documented patient medical need; and
development of new technologies
leading to efficient
transportation
services.
if the commissioner elects to assume such responsibility from
a local social services district, the commissioner shall examine and, if
appropriate,
adopt quality assurance measures that may include, but are
not limited to, global positioning tracking system reporting require­
ments and service verification mechanisms. Any and all reimbursement
rates developed by transportation managers under this subdivision shall
be subject to the review and approval of the commissioner. Notwith­
standing any inconsistent provision of sections one hundred twelve and
one hundred sixty-three of the state finance law, or section one hundred
forty-two of the economic development law, or any other law, the commis­
sioner is
authorized to enter into a contract or contracts under this
subdivision without a competitive bid or request for proposal process,
provided, however, that:
(a)
the department shall post on its website, for a period of no less
than thirty days:
(i) a description of the proposed services to be provided pursuant to
the contract or contracts;
(ii) the criteria for selection of a contractor or contractors;
(iii) the period of time during which a prospective contractor may
seek selection, which shall be no less than thirty days after such
information is first posted on the website; and
(iv) the manner by which a prospective contractor may seek such
selection, which may include submission by electronic means;
(b) all reasonable and responsive submissions that are received from
prospective contractors
in timely
fashion shall be reviewed by the
commissioner; and
(c) the commissioner shall select such contractor or contractors that,
in his or her discretion, are best suited to serve the purposes of this
section.
Appendix IV
2013 Title XIX State Plan
Third Quarter Amendment
Non-Institutional Services
Public Notice
­
Miscellaneous Notices/Hearings
Plan Amendment. For further information or to submit a comment,
please contact: Department of Health, Bureau of HCRA Operations &
Financial Analysis, 99 Washington Ave. - One Commerce Plaza, Suite
810, Albany, NY 12210, (518) 474-1673, (518) 473-8825 (FAX),
e-mail: spa-inquiries @health.state.ny.us
PUBLIC NOTICE
Department of Health
Pursuant to 42 CFR Section 447.205, the Department of Health
hereby gives public notice of the following:
The Department of Health proposes to amend the Title XIX
(Medicaid) State Plan for non-institutional services to comply with
enacted statutory provisions. The following changes are proposed for
Medicaid transportation services:
Non-Institutional Services
Effective on and after October 1, 2012, the Commissioner of Health
is authorized to assume the responsibility of managing transportation
services from any county local Department of Social Services. By as­
suming this responsibility, the Commissioner may choose to contract
with a transportation manager or managers to manage such transporta­
tion services in any county local Department of Social Services.
The estimated annual net aggregate decrease in gross Medicaid
expenditures attributable to this initiative contained in the budget for
state fiscal year 2012/2013 is $13.7 million.
The public is invited to review and comment on this proposed state
plan amendment. Copies of which will be available for public review
on the Department's website at:http://www.health.ny.gov/regulations/
state-plans/status
In addition, copies of the proposed state plan amendments will be
on file and available for public review in each local (county) social
services district.
For the New York City district, copies will be available at the fol­
lowing places:
New York County
250 Church Street
New York, New York 10018
Queens County, Queens Center
3220 Northern Boulevard
Long Island City, New York 11101
Kings County, Fulton Center
114 Willoughby Street
Brooklyn, New York 11201
Bronx County, Tremont Center
1916 Monterey Avenue
Bronx, New York 10457
Richmond County, Richmond Center
95 Central Avenue, St. George
Staten Island, New York 10301
For further information and to review and comment, please contact:
Department of Health, Bureau of HCRA Operations & Financial Anal­
ysis, 99 Washington Ave. - One Commerce Plaza, Suite 810, Albany,
NY 12210, (518) 474-1673, (518) 473-8825 (FAX), e-mail:
[email protected]
PUBLIC NOTICE
Department of Health
Pursuant to 42 CFR Section 447.205, the Department of Health
hereby gives public notice of the following:
The Department of Health proposes to amend the Title XIX
(Medicaid) State Plan for non -institutional services to revise provi86
NYS Register/September 26, 2012
sions of the Ambulatory Patient Group (APG) reimbursement method­
ology on or after October 1, 2012:
The Ambulatory Patient Group (APG) reimbursement methodol­
ogy is revised to include recalculated weights that will become effec­
tive on or after October 1, 2012. There is no estimated annual change
to gross Medicaid expenditures as a result of this proposal.
The public is invited to review and comment on this proposed state
plan amendment, which will be available for public review on the
Department's website athttp://www.health.ny.gov/regulations/
state_plans/status
Copies of the proposed state plan amendment will also be on file in
each local (county) social services district and available for public
review.
For the New York City district, copies will be available at the fol­
lowing places:
New York County
250 Church Street
New York, New York 10018
Queens County, Queens Center
3220 Northern Boulevard
Long Island City, New York 11101
Kings County, Fulton Center
114 Willoughby Street
Brooklyn, New York 11201
Bronx County, Tremont Center
1916 Monterey Avenue
Bronx, New York 10457
Richmond County, Richmond Center
95 Central Avenue, St. George
Staten Island, New York 10301
For further information, or to review and comment, please contact:
Department of Health, Bureau of HCRA Operations & Financial Anal­
ysis, 99 Washington Ave., One Commerce Plaza, Suite 810, Albany,
NY 12210, (518) 474-1673, (518) 473-8825 (FAX), e-mail:
spa-inquiries@health. state.ny.us
PUBLIC NOTICE
Department of Health
Pursuant to 42 CFR Section 447.205, the Department of Health
hereby gives public notice of the following:
The Department of Health proposes to amend the Title XIX
(Medicaid) State Plan for non-institutional services to revise provi­
sions of the Ambulatory Patient Group (APG) reimbursement method­
ology on or after October 1, 2012:
The Ambulatory Patient Group (APG) reimbursement methodol­
ogy is revised to include recalculated weights that will become effec­
tive on or after October 1, 2012. There is no estimated annual change
to gross Medicaid expenditures as a result of this proposal.
The public is invited to review and comment on this proposed state
plan amendment, which will be available for public review on the
Department's website athttp://www.health.ny.gov/regulations/
state-plans/status
Copies of the proposed state plan amendment will also be on file in
each local (county) social services district and available for public
review.
For the New York City district, copies will be available at the fol­
lowing places:
New York County
250 Church Street
New York, New York 10018
Appendix V
2013 Title XIX State Plan
Third Quarter Amendment
Non-Institutional Services
Responses to Standard Access Questions
APPENDIX V
NON-INSTITUTIONAL SERVICES
State Plan Amendment #13-23
CMS Standard Access Questions & Assurances
The following questions have been asked by CMS and are answered by the
State in relation to all payments made to all providers under Attachment
4.19-B of the state plan.
1. Specifically, how did the State determine that the Medicaid provider
payments that will result from the change in this amendment are
sufficient to comply with the requirements of 1902(a)(30)?
Response: Under SPA #12-33, the Commissioner of Health is authorized to
assume the responsibility of managing transportation services from any
county local department of social services and, in such case, may choose to
contract with a transportation manager or managers to oversee transportation
services in any county local department of social services. There is no
change to the Department's method of determining Medicaid provider
payments.
This authority was provided to the Commissioner of Health by Article VII
language, Chapter 109 of the Laws of 2010, amending Section 365-h of the
Social Service Law. The resulting State Medicaid transportation management
initiatives, including New York City and the Hudson Valley region, are
Medicaid Redesign Team proposals.
The Commissioner's authority to contract for professional management of
Medicaid transportation will be used to improve the delivery of this crucial
service, and better align the State's fiscal and program accountability. This
authority will be exercised in close collaboration and consultation with local
social services and county officials in a manner that ensures compliance with
both State and local regulations, and consumer satisfaction standards.
Furthermore, the assumption of transportation management by the State
represents significant mandate relief for localities by shifting the responsibility
for administering Medicaid transportation to a contractor operating under the
direction of the Department of Health.
Contractors hired by the Department through the use of the Commissioner's
authority manage the fee-for-service Medicaid transportation and do not
contract with transportation providers. Also, there is no resulting change to
the Department's the transportation provider reimbursement methodology or
the fee approval process.
2. How does the State intend to monitor the impact of the new rates and
implement a remedy should rates be insufficient to guarantee required
access levels?
Response: The State has various ways to ensure that access levels in the
Medicaid program are retained and is currently not aware of any access
issues, particularly since there is excess bed capacity for both hospitals and
nursing homes. Additionally, hospital and nursing home providers must notify
and receive approval from the Department's Office of Health Systems
Management (OHSM) in order to discontinue services. This Office monitors
and considers such requests in the context of access as they approve/deny
changes in services. Finally, providers cannot discriminate based on source
of payment.
For providers that are not subject to an approval process, the State will
continue to monitor provider complaint hotlines to identify geographic areas of
concern and/or service type needs. If Medicaid beneficiaries begin to
encounter access issues, the Department would expect to see a marked
increase in complaints. These complaints will be identified and analyzed in
light of the changes proposed in this State Plan Amendment.
Finally, the State ensures that there is sufficient provider capacity for
Medicaid Managed Care plans as part of its process to approve managed
care rates and plans. Should sufficient access to services be compromised,
the State would be alerted and would take appropriate action to ensure
retention of access to such services.
3. How were providers, advocates and beneficiaries engaged in the
discussion around rate modifications? What were their concerns and
how did the State address these concerns?
Response: This change was enacted by the State Legislature as part of the
negotiation of the 2010-11 Budget. The impact of this change was weighed in
the context of the overall Budget in the State. The legislative process
provides opportunities for all stakeholders to lobby their concerns, objections,
or support for various legislative initiatives.
4. What action(s) does the State plan to implement after the rate change
takes place to counter any decrease to access if the rate decrease is
found to prevent sufficient access to care?
Response: Should any essential community provider experience Medicaid
or other revenue issues that would prevent access to needed community
services, per usual practice, the State would meet with them to explore the
situation and discuss possible solutions, if necessary.
5. Is the State modifying anything else in the State Plan which will
counterbalance any impact on access that may be caused by the
decrease in rates (e.g. increasing scope of services that other provider
types may provide or providing care in other settings)?
Response: Over the course of the past three years, the State has
undertaken a massive reform initiative to better align reimbursement with
care. When fully implemented, the initiative will invest over $600 million in the
State's ambulatory care system (outpatient, ambulatory surgery, emergency
department, clinic and physicians) to incentivize care in the most appropriate
setting. The State has also increased its physician reimbursement schedule
to resemble Medicare payments for similar services, thus ensuring continued
access for Medicaid beneficiaries. Further, the State is implementing
initiatives that will award $600 million annually, over five years, to providers
who promote efficiency and quality care through the Federal-State Health
Reform Partnership(F-SHRP)/ NYS Healthcare Efficiency and Affordability
Law (HEAL). While some of these initiatives are outside the scope of the
State Plan, they represent some of the measures the State is taking to ensure
quality care for the State's most vulnerable population.
ACA Assurances:
1. Maintenance of Effort (MOE). Under section 1902(gg) of the Social
Security Act (the Act), as amended by the Affordable Care Act, as a
condition of receiving anyFederal payments under the Medicaid program
during the MOE period indicated below, the State shall not have in effect
any eligibility standards, methodologies, or procedures in its Medicaid
program which are more restrictive than such eligibility provisions as in
effect in its Medicaid program on March 10, 2010.
MOE Period.
n Begins on: March 10, 2010, and
n
Ends on: The date the Secretary of the Federal Department of Health
and Human Services determines an Exchange established by a State
under the provisions of section 1311 of the Affordable Care Act is fully
operational.
Response: This SPA complies with the conditions of the MOE provision of section
1902(gg) of the Act for continued funding under the Medicaid program.
2. Section 1905(y) and (z) of the Act provides for increased FMAPs for
expenditures made on or after January 1, 2014 for individuals determined
eligible under section 1902(a)(10)(A)(i)(VIII) of the Act. Under section
1905(cc) of the Act, the increased FMAP under sections 1905(y) and (z)
would not be available for States that require local political subdivisions to
contribute amounts toward the non - Federal share of the State's
expenditures at a greater percentage than would have been required on
December 31, 2009.
Prior to January 1, 2014 States may potentially require contributions by
local political subdivisions toward the non - Federal share of the States'
expenditures at percentages greater than were required on December 31,
2009. However, because of the provisions of section 1905(cc) of the Act,
it is important to determine and document /flag any SPAs/ State plans
which have such greater percentages prior to the January 1, 2014 date in
order to anticipate potential violations and / or appropriate corrective
actions by the States and the Federal government.
Respo nse: This SPA would [ ] / would not [ 3 ] violate these provisions, if they
remained in effect on or after January 1, 2014.
3. Please indicate whether the State is currently in conformance with the
requirements of section 1902(a)(37) of the Act regarding prompt
payment of claims.
Response: This SPA does comply with the requirements of section 1902(a)(37) of
the Act regarding prompt payment of claims.
Tribal Assurance:
Section 1902(a)(73) of the Social Security Act the Act requires a State in
which one or more Indian Health Programs or Urban Indian Organizations
furnish health care services to establish a process for the State Medicaid
agency to seek advice on a regular ongoing basis from designees of Indian
health programs whether operated by the Indian Health Service HIS Tribes
or Tribal organizations under the Indian Self Determination and Education
Assistance Act ISDEAA or Urban Indian Organizations under the Indian
Health Care Improvement Act.
IHCIA Section 2107(e)(I) of the Act was also amended to apply these
requirements to the Children's Health Insurance Program CHIP.
Consultation is required concerning Medicaid and CHIP matters having a
direct impact on Indian health programs and Urban Indian organizations.
a) Please describe the process the State uses to seek advice on a regular
ongoing basis from federally recognized tribes Indian Health
Programs and Urban Indian Organizations on matters related to
Medicaid and CHIP programs and for consultation on State Plan
Amendments waiver proposals waiver extensions waiver amendments
waiver renewals and proposals for demonstration projects prior to
submission to CMS.
b) Please include information about the frequency inclusiveness and
process for seeking such advice.
c) Please describe the consultation process that occurred specifically for
the development and submission of this State Plan Amendment when
it occurred and who was involved.
Response: The process that New York State uses is detailed in SPA #11-06, which
was approved by CMS on 8/4/11. The tribal leaders were sent information regarding
the SPA via postal mail, and the health clinic administrators were emailed the same
information. Copies of tribal consultation are enclosed.